test #42 4.30 Flashcards
1
Q
gross cirrhotic liver
A
diffuse hepatic fibrosis w/ regenerative nodules
2
Q
granulomatous destruction of bile ducts w/ lymphocytic infiltrate
A
primary biliary cirrhosis
3
Q
onion-skin bile duct fibrosis
A
primary sclerosing cholangitis
4
Q
glossopharyngeal n fxn
A
- somatic motor: stylopharngeus only
- parasympathetic: otic ganglion: parotid gland
- general sensation:
-inner surface of tympanic membrane
- eustachian tube
- posterior 1/3 of tongue
- tonsilar region
- upper pharynx (afferent gag)
- carotid body
- carotid sinus - visceral sensation:
taste posterior 1/3 of tongue
5
Q
describe path of parotid gland innervation
A
inferior salivatory nucleus CN IX otic ganglion travel along auriculotemporal n (CN V) parotid gland
6
Q
salivation from submandibular & sublingual gland from? parotid?
A
submandibular & sublingual
FACIAL
- superior salivatory nucleus, CN VII (facial) via chorda tympani n (lingual n) across submandibular ganglion
parotid:
GLOSSOPHARYNGEAL
- inferior salivaatory nucleus, CN IX (glossopharyngeal), otic ganglion, travel w/ auricotemporal n CN V
think: facial n travels THOUGH parotid, but doesn’t innervate it!
7
Q
M3 AML chromosomal translocation
A
t(15,17)
peroxidase +
8
Q
M2 AML chromosomal translocation
A
AML w/ maturation
Aur rods present, peroxidase +
t (8,21)
9
Q
molecular defect in CLL
A
deletion of 13q
10
Q
FSH, LH, estradiol in pt w/ severe anorexia
A
ALL down. inadequate hypothalamic-pituitary gonadotropic secretion
11
Q
distal ileum winding around a thin vascular stalk
A
think appel peel atresia
12
Q
causes of jejunal, ileal, colonic atresia
A
NOT abnormal fetal development / malformations.
result from VASCULAR ACCIDENTS in utero
13
Q
describe jejunal, ileas, colonic atresia process
A
vascular occlusion, diminished intestinal perfusion leads to ischemia of a segment of bowel.
subsequent narrowing / obliteration of lumen.
ileum most often affected
if SMA affect –> intestinal wall necrosis forms blind-ending proximal jejunum. terminal ileum distal to atresia forms a spiral configuration around an ileocolic vessel – “apple peel’ or ‘christmas tree’ deformity
14
Q
mechanism of duodenal atresia
A
failure of recanalization
for jejunal, ileal, colon –> vascular accident
15
Q
what favors non-renal clearance (hepatic metabolism / clearance)
A
high lipophilicity & high volume of distribution
lipophilic – lets it enter hepatocyte
– poorly eliminated in kidney as they rapidly cross tubular cell membranes after filtration
16
Q
primary site of drug excretion
A
kidney
17
Q
primary site of drug biotransformation / metabolism
A
liver (also does some excretion in bile)
18
Q
calcium chelator that prevents stone formation
A
citrate
19
Q
ulcer on lesser curvature of stomach can penetrate what artery
A
left gastric
20
Q
ulcer on duodenum can penetrate what artery
A
gastroduodenal
21
Q
where do gastric ulcers most commonly form
A
lesser curvature of stomach
transitional zone between acid-secreting epitheium of corpus & gastrin-producing epithlium of antrum
22
Q
measure of fetal lung maturity
A
lecithin/sphingomyelin ratio
(L/S ratio)
phosphatidylcholine / sphingomyelin ratio
1/1 until 3rd trimeter.
week 25 ~ 2:1 ratio
23
Q
phosphatidylcholine is also know as
A
lecithin
24
Q
how do tyramine foods trigger hypertensive crisis w/ MAOi?
A
tyramine is a sympathomimetic, usu metabolized in GI tract.
MAO inhibitors block degradation, allow it to flow in circulation
25
phenelzine
MAOi
26
tyramine containing foods
cheese, sausage, wine
27
trancypromine
MAOi
28
isocarboxazid
MAOi
29
paroxetine
SSRI
30
chlomipramine
TCA
31
depressed patient who has hypertensive crisis after cheese or wine
MAOi
32
agent in pneumonia in HIV+ w/ T-cell >800
still s. pneumonia; he is immunocompetent
33
when are HIV+ patients at risk for TB
anytime, regardless of CD4+ count
34
streptokinase
converts plasminogen --> plasmin. dissolves thrombi
also destroy: fibrinogen, factor V and VII
major side effect: hemorrhage
35
where is streptokinase derived from
beta-hemolytic bacteria! can cause HSR
36
diarrhea caught from a pet puppy?
campylobacter
domestic animal --> human
37
characterestic motility of campylobacter. growth?
"corkscrew" fashion
grows at 42 degress!
38
most common cause of acute gastroenteritis in children & adults in industrialized country?
camplyobacter jejuni
1. domestic animals
2. contaminated food (undercooked chicken, unpasteurized milk)
39
diarrhea w/ campylobacter?
inflammatory: initially watery, then bloody
40
infectious agent most associated w/ guillan-barre?
camplyobacter jejuni
41
shock w/ hyponatremia, hyperkalemia, and hypoglycemia suggests..
adrenal crisis
42
fever, vomiting, nuchal rigidity, and petechial rash suggests
meningococcal menigitis
43
Neisseria meningitis septicemia can result in..
Waterhouse-Fridrichsen syndrome; adrenal hemorrhage --> acute adrenal crisis
44
waterhouse-friedrichsen
adrenal hemorrhage w/ neisseria septicemia
45
PKA is stimulated by what upstream agent
G protein coupled receptor!
46
4 types of nonneoplastic polyps
1. hyperplastic: well-differentiated mucosal cells, form glands & crypts
2. hamartomatous: mucosal glands, smooth muscle, connective tissue.
can occur sporadically via Peutz-Jeghers or juvenile polyposis
3. inflammatory: regenerating intestinal mucosa (ulcerative colitis or crohn's)
4. lymphoid: in children. instestinal mucosa infiltrate w/ lymphocytes
47
juvenille polyps are often..
hamartomas
48
most common nonneoplastic polyp
hyperplastic.
(>50% in rectosigmoid)
serrated "saw tooth"
well differentiated musocal cells, form glands & crypts
49
determinants of adenomatous polyp malignant potential
1. degree of dysplasia
2. histologic pattern: VILLOUS more likely than tubular to transform
3. size of adenoma >4cm have 40% chance of malignancy
50
human mitochondrial DNA codes for..
37 genes for 13 proteins, 2 rRNA, 22 tRNA
produce some proteins needed for oxidative metabolic pathways
(nuclear DNA encodes for MOST proteins in mitochondria)
51
genetic code in mitochondria vs. nucleus
slightly different.
52
vitamin precursor to NAD+
tryptophan
53
what type of diet predisposes to pellagra?
corn-based!
niacin in corn is unabsorbable
54
pellagra can present in what type pt
corn-based diet
hartnup disease
carcinoid
alcoholic
55
carotene is the precursor to..
vitamin A
56
arginine is precursor to..
nitric oxide, urea, ornithine, agmatine, creatinine
57
nonsense, missense all result from
single base SUBSTITUTION
insertion/deletion --> FRAMESHIFT
58
optic neuritis, intention tremor, pain w/ ocular movements suggest
waxing & waning neuro deficits in 20-30 y/o
multiple sclerosis
SIIIN
- scanning speech
- intention tremor
- incontinence
- internuclear opthalmoplegia
- nystagmus
usu present w/ optic neuritis
59
CSF in multiple sclerosis
elevated IgG
- oligoclonal band on electrophoresis
suggests activation of B cells
60
in what population is multiple sclerosis more common
temperate latitudes, USA, Canada, Northern Europe
61
periventricular plaques on MRI
think multiple sclerosis
62
rx: for MS
1. beta-interferon
2. natalizumab (ab against alpha 4 integrin, blocks migration of inflammatory cells across BBB)
3. baclofen - GABAb antagonist for spasticity
63
metyrapone testing
inhibits 11-b-hydroxylase. can't convert 11-beta-deoxycortisol into cortisol
REDUCE serum cortisol, which should stimulate ACTH release, which builds up deoxycortisol (metabolite in urine -> 17-hydroxycorticosteroid)
unlike cortisol, deoxycortisol does not inhibit ACTH release.
normal HPA axis: increase 11-deoxycortisol in serum. increase 17-hydroxycorticosteroid in urine.
64
test for normal ACTH secrection (HPA-adrenal axis)
metyrapone testing
reduce serum cortisol,
expect elevated ACTH,
will generate elevated 11-deoxycortisol in serum & 17-hydroxycortisol in urine
bc metyapone blocks 11-b-hydroxylase
65
before prescribing isotretinoin (accutane) for acne, what must be checked
pregnancy test!
| serum b-HCG
66
how does isotretinoin reduce acne
inhibits follicular epidermal keratinization, loosening keratin plugs of comedones, facilitating their expulsion.
reduces size of sebaceous glands and inhibits sebum production.
TERATOGEN & HYPERTRIGLYCERIDEMIA
67
fate of duodenal ulcer on anterior wall? posterior wall?
anterior wall: perforate
posterior wall: hemorrhage (gastroduodenal artery)
68
what is the duodenal bulb
begins at pylorus, ends at neck of gallbladder, and rests posterior to gallbladder & liver.
head of pancreas located inferiorly
69
major toxicity of thiazolidinediones
hepatoxoticity, must monitor LFTs
70
thazolidinediones can be used for..
metabolic syndrome, nonalcoholic fatty liver disease (NASH), PCOS
(insulin resistance)
71
for what drugs must thyroid function tests be monitored
amiodarone and lithium
72
what diabetes drugs cannot be used w/ renal problems?
metformin! the risk of lactic acidosis increases w/ renal failure
73
side effects of thiazolidinediones (2)
hepatotoxicity
fluid retention, which can exacerbate CHF if have underlying cardiac problems.
74
niacin side effects
- hyperuricemia
- hyperglycemia (insulin resistance --> acanthosis nigricans)
- flushing (vasodilation)
75
rx for essential tremor
propanolol
76
inheritance of essential tremor
autosomal dominant
77
tremor when holding posture
essential tremor
78
resting tremor
parkinsons
79
charcoal yeast extract agar supplemented w/ cysteine
Legionella
80
subthalamic nucleus
major excitatory input to GPi, when then strongly inhibits thalamus
81
direct path in basal ganglia
putamen -> GPi -> thalamus
82
indirect path in basal ganglia
putamen -> GPe -> subthalamic nuclei -> Gpi -> thalamus
83
damage to subthalamic nucleus results in..
contralateral hemiballiusmus
| no longer stimulating GPi to inhibit thalamocortical circuit. now: thalamocortical circuit too active
84
clinical presentation of wilson'd disease basal ganglia degeneration
wing-beating tremor, psychosis, cirrhosis
85
dejerine-roussy syndrome
central post-stroke pain syndrome, after thalamic stroke
have numbness, tingling, burning, stabbing pain on one half of body, contralateral to thalamic stroke
86
Meniere's disease
increased volume of endolymph in inner ear (due to decreased resoption)
distention damages both vestibular and cochlear components of inner ear
triad:
1. tinnitus
2. vertigo
3. hearing loss
87
distinguishing vertigo from meniere's disease vs. schwanoma in cerebellopontine angle
same triad:
1. tinnitus
2. vertigo
3. hearing loss
meniere: wax & wane. episodic
schwanomma of CN VIII: progressive and constant
88
vertigo vs. diziness
vertigo: sensation of motion in absence of actual motion
dizziness: sensation of lightheadedness
89
central vs. peripheral vertigo
peripheral: meniere, semicircular canal debris, etc
- >positional testing, delayed horizontal nystagmus
central: i.e. stroke of vestibular nuclei, posterior fossa
- >positional testing, immediate nystagmus in any direction, may change directions.
90
airway flow rate is directly related to? inversely related to?
directly related to pressure difference in alveoli & mouth
inversely related to airway resistance
91
describe airway resistance
like vessels, airway resistance inversely related to cross-sectional area of conductive vessel.
92
describe why pulmonary fibrosis has increased FEV1 (expiratory flow rate)
decreased lung compliance (increased elastic recoil & increased radial traction (interstitial fibrosis) --> less airway resistance, increased expiratory flow rate
93
describe why emphysema/COPD has reduced FEV1 (expiratory flow rate)
airways narrowed / loss of radial traction on airways--> increased airway resistance, so reduced expiratory flow rate.
94
CEA is produced by..
70% of colorectal & pancreatic cancer
95
CA 19-9 is produced by
pancreatic cancer
96
AFP is related to which cancer
hepatocellular cacinoma
nonseminomatous testicular germ cell cancer (i.e. yolk sac)
97
CA-125
secreted by malignant ovarian epithelial tumors
90% with advanced ovarian carcinoma have it. 50% w/ early stage.
98
b-HCG is produced with which pathology
hydatidiform mole
choriocarcinoma
gestational trophoblastic tumor
99
Ca-15-3 / CA-27-29
breast cancer
100
RET gene
membrane bound tyrosine kinase receptor
mutated in 95% of familial medullary thyroid cancer & many sporadic too
activating mutation in proto-oncogene
101
RAS mutations are common in..
AMP kinase pathway -- cell prolif
follicular thyroid cancer, follicular adenoma
102
anaplastic thyroid carcinoma often have..
inactivating p53 mutations
103
Curling ulcers
ulcers in proximal duodenum in associated w/ severe trauma or burn
104
Cushing ulcer
ulcer in esophagus, stomach, or duodenum in patients w/ high intracranial pressure
direct stimulation of vagus nerve, hypersecretion of acid
105
chronic gastritis w/ antral sparing
autoimmune, type A
106
chronic antral predominant gastritis
h. pylori
107
intestinal subtype of gastric adenocarcinoma
intestinal: arises from precursor lesion
intestinal glands similar in appearance to those of colonic adenocarcinoma
108
diffuse subtype of gastric adenocarcinoma
characterized by signet ring cells
109
epiphyseal cartilage is also known as..
growth plate
diaphysis, metaphysis, epiphyseal cartilage, epiphysis
110
short stature in growth hormone / IGF-1 deficiency
will be proportional, in both axial and appendicular skeleton
unlike achondroplasia, where normal axial length, short appendicular limbs
111
most common location for anal fissure
posterior midline (poorly perfused), distal to dentate line.
severe tearing pain w/ passage of bowel movement.
may see skin tag.
associate w/ low fiber diet
112
mannitol primary affects (2) of renal tubules
1. PCT
| 2. descending loop of henle
113
spironolactone good for heart failure?
diuretic, and also prevents aldosterone induced cardiac remodeling
114
ethacrynic acid
loop diuretic
115
bumetanide
loop diuretic
116
how much cardiac output does the brain receive?
15%
consumes 20% of all O2 in body
117
when does PCO2 cause cerebral dilation? when does PO2?
PCO2 -- linear change!
PO2 -- only kicks in <50mmHg (very low)
118
why must supplemental oxygen be used carefully in COPD patients?
chronic hypercapnia causes oxygen to be primary mediator of respiratory drive.
O2 supplementation can lead to respiratory suppression & coma
119
team physician's responsibility
overriding duty of all physicians is to protect health & safety of patient.
preferences expressed by patient cannot influence decision
student athletes sign authorization form permitting physician to SHARE health info w/ coaches (family educational rights & privacy act)
employed by university, not the personal physician. exception to HIPAA.
120
acute onset heart failure after recent viral infxn..
think dilated cardiomyopathy caused by viral myocarditis
121
dilated cardiomyopathy excludes what causes
dilation due to..
coronary artery disease, valvular pathology, congenital disorders
typically a diagnosis of exclusion
122
progressive pathophysiology of dilated cardiomyopathy
1. initial ventricle dilation and dysfunction w/ progressive biventricular myocardial failure
2. reduced stroke volume --> increased ventricular end-systolic and end-diastolic volumes
3. ventricular dilation --> regurgitation across AV valves
123
progression of primary biliary cirrhosis
1. precirrhotic:
intralobular bile ducts destroyed by granulomatous inflammation "florid duct lesions"
&
heavy portal tract infiltrate of macrophages, lymphocytes, plasma cells, eosinophils
(like graft vs. host disease!)
2. eventually progressive hepatic damage due to obstructed intrahepatic bile flow.
liver -> green and micronodular
124
graft vs. host disease histologically mirrors what liver pathology
primary billiary cirrhosis
granulomatous lesions of intralobular bile ducts.
heavy portal tract infiltration of macrophage, lymphocyte, plasma cells, and eosinophils.
125
liver in budd-chiari
thrombosis of hepatic vein
hepatomegaly, abdominal pain, ascites
liver: swollen, reddish purple, tense capsule
126
liver in acetominophen toxicit
centrilobular necrosis, that can extend to include entire lobule
127
deficiency in crigler-Najjar
autosomal recessive
absent UGT
uridine diphosphate glucuronyltransferase in endoplasmic reticulum
present as baby w/ persistent jaundice, muscle rigidity, lethargy, seizure
128
fate of excess conjugated bilirubin
water soluble, bound to albumin, can be excreted in urine
129
fate of excess unconjugated bilirubin
insoluble in water! deposits in tissue, including brain
leads to kernicterus--> bilirubin encephalopathy
130
dubin johnson deficiency
autosomal recessive
absence of biliary transport protein MRP2 -- hepatocellular excretion of bilirubin glucoronides into bile canaliculu
dark liver
131
rotor syndrome deficiency
rare autosomal
asymptomatic conjugated hyperbilirubinemia.
numerous defects in hepatic uptake & excretion of bilirubin pigments
no black liver
132
bile acid deconjugation
removal of glycine and taurine, rendering less soluble, impairing reabsorption of bile acid and fat absorption
done by anareobes
133
CD19+ CD20+
precursor B cell
134
CD1+ CD2+ CD5+
precursor T cell
135
describe lymphoblast
immature, high nuclear-to-cytoplasmic ratio, variably condensed nuclear chromatin, prominent nucleoli
136
B-ALL presentation
Tdt+, CD19+, CD20+
bone marrow failure; thrombocytopenia and/or anemia and/or neutropenia
usu young child
137
presentation of T-ALL
usu teen, adolescent
high leukocyte count, large mediastinal mass.
TdT+, CD1a, CD3, CD4, CD5, CD8
138
cell markers of CLL/SLL
| mature B cell lymphoma
CD19+ B cell marker
CD5+ T cell marker
neoplasm of small, round, monomorphic B-lymphocytes in peripheral blood, bone marrow, and lymph nodes.
139
CD19+ CD5+
B cell, T cell marker respectively
CLL/SLL, mature B cell leukemia
140
how to distinguish precursor B-ALL and precursor T-ALL
only w/ immunophenotyping for CD status
141
TdT+
marker for pre-B cell and pre-Tcell
